HEAD INJURIES IN INFANTS (0-1 YEARS)
- D. Voinescu1, Saceleanu2*, I. Luca-Husti3, I. Rusu5, A.V. Ciurea3,4
“Carol Davila” University of Medicine and Pharmacy Bucharest Faculty of Medicine
- Elias Emergency Hospital Neurosurgical Department “Lucian Blaga” University, Faculty of Medicine
- Neurosurgery Department
- “Sanador” Clinical Hospital, Bucharest; Carol Davila” University of Medicine and Pharmacy Bucharest Faculty of Medicine
- Neurosurgical Departament
- Bucharest Emergency University Hospital Neurosurgical Departament
*Corresponding author. E-mail:
HEAD INJURIES IN CHILD (0-1 YEARS) (Abstract): Head injuries are one of the major causes of morbidity and mortality in children. The most common causes are falls from the same level. Boys are twice more prone to head injuries than girls. The traumatic path ology of the first 3 years of life is completely different when compared to that of adults. Material and methods: Retrospective study of all infants aged 0-1 years admitted for head injuries to the pediatric neurosurgery departments of “Bagdasar-Arseni” Hospital and “Sanador” Hospi- tal in Bucharest. This 17-year study (January 1st, 2000-December 31st, 2016) included 509 patients aged 0 to 3 years. Results: Of these, 111 (21.8 %) were aged under 1 year, presented to the Emergency Department (ED), were hospitalized for at least 24- hour observation, and were diagnosed with at least one traumatic head injury visible on the imaging studies. The level of consciousness in infants was assessed by using a variant of the Glasgow Coma Scale (GCS) adapted to this age (0-1 years), namely Pediatric Glasgow Coma Scale (PGCS). CT with Bone-window is the first investigation in case of a head injury. Conclusions: Infants show a different pathology from that at other ages. Head injuries in infants pose multiple di f- ficulties related to diagnosis, complications and follow-up. The data obtained from unen- hanced CT scans constitute an emergency assessment. Keywords: HEAD INJURY, CHILD 0-1 YEARS, CT SCAN, PEDIATRIC NEUROSURGERY, GLASGOW COMA SCALE, GLASGOW PEDIATRIC COMA SCALE
Head injuries (HI) are one of the most important causes of mortality, morbidity and transient or permanent disability in the general population, both in adults and in children. In the USA, the incidence of HI among the children aged 0-4 years is about 1256/100,000 population (1, 2).
The clinical manifestations of pediatric and adult HI differ even when they share a common cause. Raimondi (1998) empha- sized the importance of the differences be- tween adult and pediatric pathology con- cluding that” the newborn is not a baby, the baby is not a school child”, just ”the teenag- er is not a child” and even more ”adults are completely different from children” (3).
The most common causes of HI in in- fants are accidental falls from the same level or from height, traffic accidents in which children may be involved both as passengers and as pedestrians, accidents with various objects and child abuse (4).
When an infant presents to the Emer- gency Department with head injury, unen- hanced CT brain scan is the initial imaging modality of choice. This is the “gold- standard” investigation for head injuries, and is preferred due to its accessibility and good visualization of bleeding injuries, solutions of continuity in calvaria with or without dural or cerebral expansion in the bone gap or cerebral edema lesions (5).
MATERIAL AND METHODS
All patients with HI aged 0 to 3 years admitted to the departments of pediatric neurosurgery of “Bagdasar-Arseni” Hospital and “Sanador” Hospital in Bucharest be- tween January 1st, 2000 and December 31st, 2016 were included in this 17-year study. Of the 509 pediatric patients, 111 (21.8 %) were aged under 1 year. In this study group, we encountered a category of injuries caused by obstetrical trauma related to fetal dystocia or instrumental delivery.
All patients included in the study were admitted for at least 24-hour observation, and were diagnosed with at least one post- traumatic injury visible on imaging studies. To analyze patients’ state of conscious- ness, the authors used the Pediatric Glas- gow Coma Scale (PGCS), a variant of the Glasgow Coma Scale (GCS) adapted for pediatric patients (6) (tab. I).
TABLE I
Pediatric Glasgow Coma Scale (6)
Best verbal response |
Best eye response |
Best motor response |
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RESULTS
The level of consciousness determined with PGCS in the 0-1-year group is pre- sented in Table II.
As to the etiology of HI in infants the most common causes in this study group were falls from the same level or from another level and traffic accidents. A spe- cial category is represented by the injuries caused by physical aggression (tab. III).
TABLE II
PGCS evaluation of the level of con- sciousness in the 111 infants
GPCS |
No. of cases |
Percentage |
15-13 points |
79 |
71.1 |
12-9 points |
20 |
17.9 |
<8 points |
12 |
10.8 |
Total |
111 |
100.00 |
TABLE III
Causes of head injuries in infants (0-1 years)
Cause |
No. of cases |
Percentage |
Fall from the same level |
41 |
36.9 |
Fall from another level |
35 |
31.5 |
Road accidents |
23 |
20.7 |
Accidents at play |
5 |
4.5 |
Aggression (Child abuse) |
4 |
3. |
Other causes |
3 |
2.7 |
Total |
111 |
100 |
His are extremely varied, a frequent finding pallor, encountered in all study cases. Infants who were in pain were agi- tated and anxious. Another clinical catego- ry was the symptoms of increased intracra-nial pressure expressed by the anterior fontanelle bulging, vomiting, convulsive events, motor deficiencies or anisocoria and alteration of consciousness in various degrees (tab. IV).
TABLE IV
Clinical Symptomatology reported at Emergency Room
Clinical symptomatology |
No. of cases |
Percentage |
Pallor skin |
111 |
100 |
Irritability with agitation |
60 |
54.1 |
Irritability and drowsiness |
42 |
37.8 |
Anterior fontanelle bulging |
39 |
35.1 |
Vomiting |
26 |
23.4 |
Convulsive seizures |
21 |
18.9 |
Motor deficits |
15 |
13.5 |
Anisocoria |
9 |
8.1 |
Impaired consciousness/coma state |
12 |
10.8 |
The post-traumatic injuries seen on CT scans most frequently encountered in the hospitalized patients (111 cases; 21.8%) were: skull fractures of several types, ceph- alohematoma, extradural hematomas and DAIs (tab. V).
Acest studiu se regaseste integral in Revista Medico Chirurgicala a Societatii de Medici si Naturalisti din Iasi, Volumul 121, Numarul 2, Aprilie-Iunie 2017.
Mai jos gasiti link-ul de descarcare al intregului articolului in format PDF.
https://www.revmedchir.ro/index.php/revmedchir/article/view/100/76